A 2009 Oxfam paper puts forth the view that scaling-up private healthcare provision is very unlikely to deliver high-quality care to the poor. Commenting on the paper, Jishnu Das contends that while it is right to argue for investments that improve public healthcare and build State capacity, we will not get there by demonising the private sector.
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Vaccination is the mainstay of prevention strategies for Japanese encephalitis – the child killer disease that recently caused many deaths in Gorakhpur, Uttar Pradesh. In this article, Dr Kaushik Bharati discusses why the vaccine drive in India has failed to reach its full potential in the fight against the disease, and what can be done about it.
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Access to healthcare is constrained by three key factors – physical access to healthcare facilities, ability to pay, and quality of care. In this note, Udayan Rathore discusses how within poor households, women and children suffer disproportionately more on account of these constraints.

The recent controversy around multiple child deaths in a public hospital in Gorakhpur district in Uttar Pradesh has brought the focus back on Japanese Encephalitis – the child killer disease. In this article, Smriti Sharma contends that a holistic, intersectoral approach is required to tackle the issue.
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A new
synthesis paper (Menon 2017) produced by the International Growth Centre brings together evidence from various health-related IGC studies on India undertaken over the past seven years, to draw implications for health policy. At a workshop organised by IGC in collaboration with Ideas for India and Indian Statistical Institute, Srinath Reddy (Public Health Foundation of India), Alok Kumar (NITI Aayog), and Karthik Muralidharan (University of California, San Diego) discussed key policy lessons emerging from research, and areas where further work is required.
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River Brahmaputra which flows across the Northeast Indian state of Assam, carves out a network of nearly 2,300 islands, isolating them from the mainland and excluding their inhabitants from access to basic infrastructure and health facilities. Based on her fieldwork, Anjali Mariam Paul describes the working of an innovative intervention in health communication – a non-commercial grassroots community radio station for these river islands.
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The Delhi government planned to set up 1,000 mohalla or community clinics in the state by end-2016, but only one-tenth of the target was met in the proposed timeline. In this article, public health expert Chandrakant Lahariya contends that in the success or failure of this initiative, at stake is the future of the efforts to reform the health system and strengthen primary healthcare in urban areas across Indian states.
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As part of the Digital India initiative, All India Institute of Medical Sciences (AIIMS) issues a Unique Health Identification (UHID) number to each patient, which documents their entire journey in the hospital. AIIMS has called for a mandatory linkage between UHID and Aadhaar. In this article, Mudit Kapoor, Associate Professor at ISI Delhi Centre, explains how this step can have significant positive implications for delivery and democratisation of healthcare.
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To address absenteeism among staff at public healthcare facilities, the government of Karnataka introduced an innovative biometric device to monitor and enforce attendance rules. This column presents findings of a large randomised evaluation of the programme. While some health gains were achieved, imperfect enforcement illustrates the limits of monitoring solutions if there are constraints on full implementation in practice.
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India’s progress in reducing infant and maternal mortality is rather slow. This column shows the extent of shortfall of gynaecologists and auxiliary nurse midwives - the frontline of the battle against infant and maternal mortality – across health facilities in the country. It argues that along with absenteeism in public services, vacancies is a crucial area that requires improvement.
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In a panel discussion organised to mark the 4th anniversary of Ideas for India, I4I Editor Parikshit Ghosh (Delhi School of Economics) moderates a discussion on ‘Two years of Modi government’ among Pranab Bardhan (University of California, Berkeley), Mihir Sharma (Bloomberg View) and Pratap Bhanu Mehta (Centre for Policy Research), encompassing issues related to policy and governance; corruption; manufacturing; social sector; and social and cultural issues.
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Informal healthcare providers are the most common, and sometimes the only source of healthcare, in much of rural India. In this article, Jishnu Das of the World Bank argues that informal providers should be trained and their impact evaluated to see if it improves healthcare for poor people.
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In this article, Pranab Bardhan, Professor of Graduate School at the Department of Economics, University of California, Berkeley, provides his perspective on the performance of the Modi government in its first two years in office.
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Private health insurance covering tertiary diseases is limited to the upper middle class in India. One reason for low take-up of publicly-financed health insurance among economically weaker sections is that treatment of tertiary diseases relies critically on specific information on facilities and treatment options. This column presents evidence from Andhra’s Aarogyasri programme suggesting that community networks might be an important channel through which such information is obtained.
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Health data from the National Sample Survey shows an increase in morbidity in India over the years. However, given that the data is self-reported, it is difficult to ascertain whether this indeed reflects higher actual illness burden or an enhanced perception of morbidity. This column shows that reporting behaviour varies systematically with socio-demographic characteristics, and this can be used to disentangle perceived and actual morbidity.
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Cash transfers to the poor, conditional on use of particular public services, are a popular tool to increase healthcare utilisation. This column evaluates the impact of one such scheme – Janani Suraksha Yojana - and finds that it encouraged pregnant women to deliver babies at healthcare facilities. It also suggests that the marginal effect of cash incentives is larger when provided to healthcare workers rather than mothers.
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The dengue virus has infected 25,000 people in India this year, with about 6,000 in Delhi alone. In this article, Chandrakant Lahariya, a public health policy expert, contends that the dengue situation represents a failure of local public health administration, and calls for a holistic approach to address the root causes and ensure long-term solutions.
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The Indian government is working on drafting a new national health policy and designing a health assurance mission, in parallel with developing its national health accounts. In this article, Nata Menabde and Chandrakant Lahariya – public health policy experts at the World Health Organization - contend that this opportunity has the potential to transform the health status of millions of Indians and achieve universal health coverage.
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About a year ago, the Prime Minister’s Office in India announced the introduction of four new vaccines in the national immunisation programme. In this article, Chandrakant Lahariya, a public health policy expert, discusses the significance of the decision. He highlights gaps between policy decisions and action with respect to the immunisation programme in the past, and emphasises the need for speedy and effective implementation of the announcement.
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The 14th Finance Commission has recommended devolving a greater share of revenues to states in order to give them more control over spending. In this article, Amanda Glassman and Anit Mukherjee examine the current centre-state relationships in the context of the health sector in India. They recommend that centre-to-state transfers should be performance-related, and should seek to, at least partly, level the playing field across states.
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The National Health Assurance Mission – India’s first move towards Universal Health Coverage – is expected to be launched soon. In this context, this column analyses the extent, distribution and quality of current public spending on healthcare. It suggests that the planning for a national programme for health coverage should take into account issues of fragmentation, inequity and inefficiency in the public healthcare system.
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Janani Suraksha Yojana - India’s safe motherhood programme – provides poor women with a financial incentive for delivering births at health centres and seeking antenatal and postnatal care. This column finds that the programme has had limited success. While women with no formal education and those from rural areas have benefitted disproportionately, the programme has failed to reach the poorest women.
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Given the insufficient public investment in the health sector in India, optimal utilisation of resources in the sector is crucial. This column analyses the efficiency of secondary government hospitals in West Bengal. It finds a huge slack in the use of resources such as doctors. With better monitoring, hospitals will be able to serve more patients with existing resources.
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A key component of the National Rural Health Mission launched by the Indian government in 2005 was the introduction of a cadre of village-level Community Health Workers known as ASHAs. This column analyses the impact of the ASHA programme on childhood immunisation, and finds that ASHAs have had a positive impact by generating awareness regarding the need and availability of immunisation.
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Given that India has better infrastructure for schooling relative to healthcare, and near universal primary school enrolment rates, many believe that providing basic health services through schools rather than clinics may be more cost effective. This column finds that coverage achieved by health programmes administered through schools is also low, even lower than the average school attendance rates. The key constraint on coverage is shortage of healthcare personnel.
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As part of a special three part series, the Prime Minister’s rural development fellows bring us voices from the field about what development means to women in some of the most remote parts of the country. What is the impact of government programmes on the day to day lives of the people they are supposed to help? The first account in this series is of Kajalmani Soren in Lalgarh, West Bengal. Coming from a family of landless labourers, she talks about her experience with the National Rural Health Mission, the Employment Guarantee Scheme and the Public Distribution System.
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India has the highest rate of maternal deaths in the world. A major cause is that a significant proportion of women continue to deliver babies at home without the presence of a skilled attendant. This column says that distance to health facilities is a key barrier to seeking delivery care at a facility.
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While natural disasters and political turmoil rightly grab our attention, this column shows that it is everyday events that drag most people into poverty. For many, the first of these is illness and this column argues that this is where the first battle lines against poverty must be drawn. People need more affordable, accessible, and higher quality healthcare.
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